Safer Use of Antipsychotics in Youth (SUAY)
Child Behavior Disorders
About this trial
This is an interventional other trial for Child Behavior Disorders focused on measuring Youth, Mental Health, Psychotropic, Medication Safety, Quality Improvement
Eligibility Criteria
Inclusion Criteria:
- Patient is ≥ 3 and < 18 years of age at the time of the encounter at which the study alert fired (index date);
- Patient is initiating a new episode of outpatient treatment with an antipsychotic medication. (New episodes are defined by no record of an antipsychotic medication being ordered within the health system as part of an outpatient care plan in the prior 180 days);
- Study service (BH navigation, bridging therapy, CAP consult) ordered in Epic for the patient; (e.g., provider removed antipsychotic order and still ordered study services);
Exclusion Criteria:
- Patient has a diagnosed psychotic disorder, mania, autism spectrum disorder, or intellectual disability;
- Patient was enrolled in the SUAY pilot study;
- The antipsychotic entered is prochlorperazine (Comazol®);
- An outpatient antipsychotic order is entered by a temporary provider in the health system (e.g., "doc of the day"). Orders placed by temporary providers do not count towards the 180 day medication free period for defining a new episode of care.
- The antipsychotic order was placed within an urgent care, emergency department, or inpatient setting (to avoid intervening during a crisis). Orders placed in these settings do not count towards the 180 day medication free period for defining a new episode of care.
- Primary language is not English
Sites / Locations
- Kaiser Permanente Colorado Institute for Health Research
- Nationwide Children's Hospital / Partners for Kids
- Kaiser Permanente Center for Health Research - Northwest
- Kaiser Permanente Washington Health Research Institute
Arms of the Study
Arm 1
Arm 2
Sham Comparator
Experimental
Control - Medication Alert Only
Intervention - Alert + CAP Review AND Enhanced BH Access
The control arm medication alert is a simple text pop-up in the EMR that will inform the prescriber of Choosing Wisely® recommendations developed the American Psychiatric Association regarding antipsychotic medication use in children and adolescents.
The intervention alert prompts the prescriber to keep/remove the antipsychotic order, and/or order any study services: behavioral health navigation, expedited psychotherapy access, virtual consult with a child and adolescent psychiatrist (CAP). Passive case review by the study CAP will occur for all intervention arm cases. A virtual consult will be scheduled if the prescriber ordered it or the CAP needs to discuss the case. The CAP will provide the prescriber with a written summary of his/her review. Following review by the CAP, a navigator reaches out to the eligible intervention arm patient/family to offer extra support. The navigator's role is to (a) provide extra support to facilitate access and engagement in appropriate psychosocial therapies; (b) coordinate short-duration bridging therapy sessions for teens/families not engaged in psychotherapy, when appropriate; and (c) keep the prescriber informed of any clinically relevant updates.